elbow assessments

Question 1

what are the components of elbow assessments

Answer 1

• Observation
• Active movements
• Passive movements
• Accessory movements
• Isometric muscle testing
• Special tests
• Palpation
• Muscle length
• Neurological tests
• Functional tests
• Check surrounding joints

Question 2

What are the joints of the elbow

Answer 2

humeroulnar (hinge)
radiohumeral (hinge)
superior radioulnar (pivot)

Question 3

what are the key points of observation

Answer 3

• UPPER LIMB OBSERVATION
• Above Below
• Dynamic & Static Situations
• Quality of movement
• Posture characteristics
• Muscle form
• Soft tissues

Question 4

what are checks that should be made during observation

Answer 4

• Hyperextension deformity
• Limited flexion
• Medial tilt and lateral angulation at the elbow
• Prominence of lateral condyle of humerus
• Gunstock deformity
• Wasting of muscles

Question 5

what is gun-stock deformity

Answer 5

caused by malunion of supracondylar Fx

varus in coronal plane, extension in sagittal plane, internal rotation in transverse plane

Question 6

what is the expected ROM for movements around the elbow?

Answer 6

• Flexion (0-55 deg)
• Extension (0-15 deg)
• Supination (70 deg)
• Pronation (80 deg)

Question 7

what are possible accessory movements around the elbow

Answer 7

Distraction of olecranon on humerus
distraction of radius on humerus
PA glide radius on humerus
AP glide radius on humerus

Question 8

how is distraction of the olecranon from humerus conducted

Answer 8

pt in supine, 70 degrees flexion at elbow and 10 degree supination, fixate humerus with one hand and laterally pull dorisilly and distally

Question 9

how is distraction of the radius conducted

Answer 9

pt has arm resting on plinth or table, full extension with 5 degree supination

fixate humerus and palpate joint line with finger

hold radius distally and perform traction

Question 10

How is PA and AP conducted at the radius and humerus

Answer 10

pt sat with arms on plinth or table

elbow moved to 5 degree supination and slight flexion, fixate humerus one hand and palpate joint line with thumb
other hand finds radius
PA pressure is applied towards patients chest
AP remove extensors of forearm to find dip and head of radius, then movement is distal and caudal

Question 11

what muscles are tested in each isometric muscle tests?

Answer 11

Flexion: biceps brachii, brachialis, brachioradialis
Extension: triceps
Supination: supinator, biceps brachii
Pronation: pronator teres, pronator quadratus, flexor carpi radialis

Question 12

How are the varus / valgus stress tests conducted?

Answer 12

Assesses integrity of the lateral collateral ligaments

Pt standing or sat
place elbow in slight flexion and palpate humeroulnar joint line
apply varus / valgus force to elbiw
test at both 5 and 30 degrees

positive with pain / laxity

Question 13

What is the test for lateral epicondylopathy and how conducted

Answer 13

Maudsley’s test (tennis elbow)

pt with forearm on plinth/table

palpate lateral epicondyle with forearm pronated and elbow slightly flexed, extension of 3rd digit / 2nd finger is resisted

positive if pain is reproduced

Question 14

how is medial epicondylopathy identified

Answer 14

with the golfers elbow test

palpate medial epicondyle with forearm supinated and elbow and wrist extended

positive if pain on medial epicondyle

Question 15

How is ulnar nerve entrapment tested for?

Answer 15

Tinnel’s sign (elbow)

examiner percusses ulnar nerve in cubital tunnel for 30-60 secs while elbow is flexed,

positive if paraesthesia / numbness down the arm

Question 16

what functional tests are there for the elbow

Answer 16

press up test (full plank or with knees)
superman plank position
rotating hammer

Question 17

what education should be provided in relation to epicondylalgia management

Answer 17

• Avoid end range of motion extremes in both extension and flexion.
• Avoid repetitive hand and wrist motions and take breaks from such
  activities when necessary to perform them.
• Avoid letting heavy items with the arm in full extension; perform work or
  weight-lifting partially bent with the elbow.
• Use two hands to hold heavy tools and use a two-handed backhand in
  tennis.
• Limit repetitive grasping and gripping motions.
• If a movement causes the pain to return, avoid it, and report to your
  clinician’s office

Question 18

describe load management for lateral epicomdylalgia

Answer 18

optimised load allows adaptation for the tendon and helps to improve strength

helps to break tendinopathy cycle
reactive tendinopathy: tendon thickening, reduces load to reverse this

tendon dysrepair: greater matrix breakdown, increase in number of cells, increases vascularity

degenerative tendinopathy: areas of cell, little capacity for reversal

Question 19

how are exercises done for lateral epicondylalgia and progressed

Answer 19

finger flexion, wrist extension and resistance

progress to therabands and dumbbells

eventually proximal strengthening, up to 30% weakness, weakness in proximal muscles increases distal muscle demand

Question 20

what are the goals for supracondylar fracture treatment

Answer 20

achieve painless and full elbow mobility
enhance healing process
strengthen affected musculature
improve overall functional abilities

Question 21

what kind of exercises are recommended for supracondylar fractures

Answer 21

active exercise and ADLs are recommended rather than passive mob or stretching

optimal loading pain-free activities are necessary for paediatric fractures to aid healing process

should avoid activities with weight-bearing, loading and pushing

progressive strength exercises can be adressed

Question 22

what immobilization period is there for supracondylar fractures

Answer 22

elbow immobilized for 3 weeks
adjacent joints kept moving with active and active-assisted exercises frequently
elbow shouldn’t be moved

Question 23

what kind of exercises should be done 1-2 weelks after cast removal

Answer 23

gentle tissue release arm and forearm
gentle active and AA exs with wand in pain-free way frequently
isometric arm and forearm exs
educate parents and child to use affected hand to use in daily activities
avoid weight-lifting and pushing activities